Osteoarthritis Explained

Released May 12, 2026 

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Jamie Nicole: Hi, welcome to the Live Yes! With Arthritis podcast. I'm Jamie Nicole, your host for this episode. I was diagnosed with arthritis about 20 years ago. It started out in my back, ran in my family, and then it moved to my knees in 2019. Ended up having my first surgery, knee surgery, that year. Four years later, I was also diagnosed with rheumatoid arthritis, which is different than the osteoarthritis I already had. And then as recently as last year, I was told that I'm in between stage three and four of osteoarthritis in both of my knees. 

So, for today's episode, we're talking about osteoarthritis, or OA as it's commonly known. Osteoarthritis is by far the most common type of arthritis, affecting 32.5 million adults in the U.S. And by the year 2040, it's projected that 78 million adults in the U.S. will have OA. Today, we're going to explore and explain osteoarthritis: what causes it, how it affects the joints in other parts of the body, how it's treated and what you can do to help manage it. 

I'm joined by Dr. C. Benjamin Ma and Dr. Elizabeth Wellsandt. Dr. Ma is chair of the University of California San Francisco Department of Orthopedic Surgery, as well as a professor in residence in sports medicine and shoulder surgery. Dr. Ma's special interest includes sports medicine, arthroscopic shoulder surgery to repair rotator cuff tears and ligament instability, shoulder replacement, knee ligament reconstruction, and meniscus and cartilage injuries. And Dr. Wellsandt is an associate professor in the physical therapy program at the University of Nebraska Medical Center, with a courtesy appointment in UNMC's Department of Orthopedic Surgery. Dr. Wellsandt leads an interdisciplinary research team focused on patient outcomes after ACL surgery. That includes collaborators in orthopedic surgery, radiology, biomechanics and engineering. Her team also includes graduate, health professionals and undergraduate students studying movement and sports medicine. Dr. Ma, Dr. Wellsandt, welcome to the podcast. 

Dr. Elizabeth Wellsandt: Happy to be here. 

Dr. C. Benjamin Ma: Thank you for having me. 

Jamie Nicole: Beyond the credentials I just listed, tell us a little bit about yourself and your experiences with OA. 

Dr. C. Benjamin Ma: Well, maybe I'll start first. You know, obviously, my background’s as an orthopedic surgeon. We take care of a lot of people with orthopedic injuries. And one aspect of osteoarthritis is post-traumatic osteoarthritis, which is osteoarthritis that occurs after trauma. So, we do see a lot of young adults that have some of those injuries. I personally have some osteoarthritis now in my hands as the surgeon. So, certainly kind of have some personal connection about what musculoskeletal discomfort could be, yeah. 

Dr. Elizabeth Wellsandt: My training is in physical therapy, and after I worked clinically for a few years, I went on to do my PhD training in biomechanics and movement science. I've always been really interested in how we can use movement to both prevent osteoarthritis and also manage symptoms after they begin to appear. I also have a little bit of a personal history with it. I tore my ACL when I was in high school, so I'm now well over 20 years out from my ACL reconstruction and feel some of the changes that are happening within that knee as I get a little bit older. A lot of patients have OA sooner than that after their ACL injury, within only 10 or 15 years. So, I feel blessed a little bit that I've made it this long and just starting to kind of notice some small changes along the way. But that's given me a nice perspective and experience as I study these things within my own research team. 

Jamie Nicole: Historically, osteoarthritis has been called wear and tear arthritis, but in recent years, there's been some new thinking around this. Tell us what is osteoarthritis exactly and explain some of this new thinking. 

Dr. Elizabeth Wellsandt: Osteoarthritis, we also call that OA, is really this chronic disease that affects the whole joint, not just the cartilage, which is the tissue that covers the ends of the bones in the joint. For a long time, people thought of OA as simply wear and tear, where cartilage would get worn down over time. But now we know that it's probably a lot more complex than that. OA involves changes across the joint tissue, so not only the cartilage, but the bones can change structure. There can be inflammation and irritation of the joint lining inside of the joint, and even changes to structures around the joint. And inflammation, which can cause pain, definitely plays a bigger role than maybe what we once thought. 

Instead of it being an inevitable part of aging, I think we are better understanding OA as a disease that can have a lot of different complex factors that can influence the symptoms that are present. My research, along with that of others, has studied young adults who have had experiences with knee injuries such as ACL injuries. And many of those people will go on to develop OA at a much younger age than maybe what we would typically think. So, it's not always a disease of wear and tear. 

Dr. C. Benjamin Ma: Yeah, I would agree. The traditional thinking about, "Oh, I just used my joint too long, wore it out," may not be the only reason. And there's a lot of inflammation that affects not just the cartilage, but the bone and the soft tissue. We know that just because the X-ray looks like you have a lot of arthritis doesn't mean you have the same amount of symptoms. Sometimes symptoms are very different than what the pathology is. 

Jamie Nicole: Absolutely. We think of it as an aging disease or something that you get as you get older, but you kind of touched on the point that we can get it at a younger age, too. Can you speak a little bit more about that? 

Dr. C. Benjamin Ma: It's multifactorial. Obviously, you have the genetic component. Some people are more prone to get osteoarthritis. Maybe some genetic component actually makes them have inflammatory arthritis. For a patient like yourself and others that may have an inflammatory or systemic condition, it does make the joint breakdown earlier. And there are ways we could tackle that. The other thing is actually by trauma. I had an injury, I tore my ACL, I tore my meniscus, put myself more at risk. Those would cause arthritis also. It really is a broad spectrum. 

Dr. Elizabeth Wellsandt: I think a few other groups of individuals that we think of having a higher risk of osteoarthritis, are also people with obesity. Obesity tends to produce this kind of whole body low levels of inflammation, which is thought to maybe influence the risk of developing OA. People with very physically demanding jobs or that are moving in the same patterns over and over again. All of this makes it difficult sometimes to predict and manage OA because it can develop from so many different reasons. 

Jamie Nicole: Are there different types of osteoarthritis? And can you explain those to the audience? 

Dr. Elizabeth Wellsandt: Yeah. Primary or idiopathic OA is maybe the typical type of OA that we think about. This develops without a real clear cause, and it's often associated with aging or things like genetics. Post-traumatic OA happens after a joint injury, so  after an ACL reconstruction or a fracture that would involve a joint. And then secondary OA can develop because of other conditions, maybe joint alignment problems or inflammatory diseases, or even metabolic disorders that might increase the risk of developing OA. 

Jamie Nicole: What effect can OA have on the rest of your body beyond the joints? And what other conditions often accompany it? 

Dr. C. Benjamin Ma: Well, Jamie, this is a big topic, as an orthopedic surgeon, a person that cares about musculoskeletal health. If you can't walk, you can't exercise. The rest of the body's going to break down. Similar to a car, you can't drive a car around when the tires are flat. The engine's going to rust. If you actually cannot exercise, your cardiovascular disease risk just goes up. And same thing with management of diabetes. There's also some very new study results show that there is a link between activity and also dementia. For some people that are actually not able to stay active, it may be kind of a precursor for people developing neurodegenerative condition of the brain. There may be early signs of dementia. So, it does affect the rest of the body. 

Jamie Nicole: How is osteoarthritis diagnosed? 

Dr. C. Benjamin Ma: The simple tests we always do are plain X-rays, plain radiography. We actually look at how much joint space there is between the bones. We actually measure how much the width of the cartilage is. Obviously, there are other tests: ultrasounds, MRI, advanced imaging. You could also do medical diagnosis. For example, getting blood tests to look for inflammatory markers for some of the most systemic diseases like rheumatoid arthritis or lupus. 

Dr. Elizabeth Wellsandt: The clinical history and the patient history, what patients are describing to us as clinicians, is also very important. Because sometimes individuals can have an X-ray that just looks awful, but they have very little pain, and they move very well. And then you could have another person with very little damage that you can see on an X-ray, but have a lot of symptoms of pain or stiffness or swelling. And so those things don't always match. We use all of that information together to kind of paint the picture of what's going on with a person's joint. 

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Jamie Nicole: Who typically diagnoses osteoarthritis? 

Dr. C. Benjamin Ma: You could start with a primary care physician able to kind of get the initial symptoms. Could be the physical therapist. They kind of say, "Hey, this patient's not responding. Their knee's very swollen, the joint's very stiff." Could be your orthopedic surgeon. Or anybody in the musculoskeletal space, like a physiatrist. But a lot of times the diagnosis needs to be confirmed by some other test. That's where the X-rays or radiographic imaging or maybe some of the lab tests may confirm some of the diagnosis. 

Jamie Nicole: A lot of times when we have an ailment or a pain, our first line of defense is a primary care physician. It's important that we share all of the information with the doctor, because they may not be as familiar with arthritis, osteo or any other type of arthritis. 

Dr. C. Benjamin Ma: Any doctor-patient relationship is about honesty and also accuracy. Have the primary care physician understand what your symptoms are, what are you experiencing. Allow them to kind of get the right evaluation for you. If there's concern about the condition not being managed as well, then the specialist will come in and help out. 

Dr. Elizabeth Wellsandt: As a physical therapist, we're really interested in understanding movement-based restrictions that you have and how it's impacting your function. It's really helpful to us to understand what challenges you have with some of your daily movement, how that's impacting your overall ability to carry out whatever your life roles are, whether that be as a parent or professionally within your job or whatever it is, so that we can help you and design a program that helps you return to what those kind of functional and daily goals are. 

Jamie Nicole: Thank you for expanding on that. How is OA treated? And is there a cure? 

Dr. Elizabeth Wellsandt: Unfortunately, we still do not have a cure for osteoarthritis. On the flip side of that, it is manageable. There's still hope. There's still promise that we can help to manage the symptoms and some of the other consequences of having OA. In the early stages, certainly providing education to patients about what is to be expected, how they can kind of self-monitor and self-manage their symptoms. Promoting exercise and activity, a healthy body weight — managing weight can be really important — and working on some of those lifestyle changes that can help to manage some of those early symptoms. 

If things progress, certainly working with a physical therapist could be helpful to maybe develop a more targeted exercise regimen, to really work on some of the impairments and limitations that might be present at that joint. Bracing can be helpful, but it's not helpful for everybody. Medications, injections, they can be tried. And nothing is a guarantee, but it's kind of trying lots of different conservative approaches as possible. But when we reach end-stage disease, the option for that is surgery and having a joint replacement. And so, lots of work is being done across the research community to try to identify ways that, if not prevented, at least slow down its progression, so that we don't reach that need of total knee replacement so quickly. Dr. Ma, do you have more to add? 

Dr. C. Benjamin Ma: For, you know, medication and injection, as of now most of them are really treating the symptoms, not really a cure. I could foresee in our lifetime there will be a cure, that we could take a pill or do an injection that could kind of reverse some of the process that the inflammatory condition can cause. We need more research on this area. For really, really end-stage arthritis, a replacement could be really helpful. And we have made a lot of advancement in replacement joints over the years. 

Hip and knee replacements are very common. Shoulder replacements are not that far away. We obviously have finger kind of joint replacement. Same with elbow and ankle replacement also. They are lower numbers but can be done. Some of them work better than others. But there are also a small amount of arthritis that can be taken care of by less invasive surgery. For example, when you have a small cartilage lesion that actually has not progressed to really generalized osteoarthritis, there has been a lot of advancement in terms of growing your own cartilage, put it back in, or stimulating your own body to create cartilage also. So, really it depends on symptoms, degree of involvement. 

Dr. Elizabeth Wellsandt: An important piece of information, maybe to understand why we don't have a good treatment for OA yet, is that cartilage is different from some of the other tissues in our body in that it doesn't have a really good blood supply, so it doesn't just heal on its own. If we break a bone, most of the time those things heal fairly well, because there's blood flow and nutrition that can get to that area of injury and repair itself. That's not present in cartilage, which makes it a little bit more challenging for us to identify ways to prevent it or kind of treat it, beyond knee replacement or hip replacement or whatever joint is affected. 

Jamie Nicole: Everyone is different, and everybody's body is different, so treating it is going to be different, so you never can pinpoint it. Pain is a key symptom of OA. What are the best options to reduce pain? Something that happened to me: I went in for my left knee. I wasn't having pain in my right knee at the time, but from the X-ray, the doctor was more concerned about my right knee; but the issue with my left knee, there was no concern from the doctor, but that's where I was having the most pain. How do you manage it in those circumstances? 

Dr. Elizabeth Wellsandt: Pain is complex, because we have nerve endings at our joint that sense pain, but then we also interpret pain in our brain. So, it's just a very complex system. People respond differently to the different management strategies that we have. People may see a lot of benefit from participating in exercise. Exercise certainly is much more effective if it's coupled with weight management and changes in diet and nutrition. But other people might receive a lot of benefit from topical or oral medications for their pain control. Stress and our sleeping habits can also affect how we interpret pain and feel pain. And so, some people might benefit from behavioral type of interventions or different things to manage stress levels and having structured sleep schedules. 

It's not a one-size-fits-all approach. And oftentimes it's not just one single thing that's going to be helpful. It needs to be kind of a comprehensive management strategy to those things. When something hurts, our natural tendency is to stop doing what hurts and to stop moving. But that's really kind of the opposite of what is helpful for when we have OA. We need to keep our muscles strong around the joint. We need to stay active so that we can have a healthy body weight, right? I think we tend to fear movement because we think it might make it worse. Sometimes it might be helpful to work with a physical therapist to understand how you progress and ramp up your exercise and activity so that you don't go overboard. 

Jamie Nicole: I know for me personally, if I was not doing fitness, the disease progression and how I feel and how I'm able to function would be far worse. Expand a little bit more about the different types of exercises that are most beneficial. And does it get to a point where certain exercises cause more harm than good? For example, I've seen people with osteoarthritis be able to run marathons for an extended period of time; and then I have others with osteoarthritis who can barely do seated fitness. How is the audience able to gauge when the exercise is reaching a point to where it's doing more harm than good? 

Dr. Elizabeth Wellsandt: If you have some pain or soreness or maybe some more swelling in response to whatever activity, whether it's structured as exercise or just regular daily activity, how long were those symptoms? Did you experience them for maybe a day and then they kind of got better? Or were they present for a lot longer? Sometimes a little bit of soreness, muscle soreness, or even joint soreness, might be a little bit expected. But we would think that we would like to see that it gets better and that it improves. And so, that's a sign to us that the amount of activity that that person is doing is tolerated and is appropriate. If it's causing these very long periods of increased pain and affecting how you're able to function in your day, then I think that gives us information that maybe that's a little bit more than what that joint can tolerate at the time and maybe need to dial things back a little bit. 

Dr. C. Benjamin Ma: Some pain is OK, but too much pain is not great. Usually I tell patients that if it's sore after exercise, maybe OK. But if it's sore till the next day, certainly not great over there. And anytime when your joint swells up means that something's not good. Swelling means inflammation. Inflammation means something's breaking down. 

Dr. Elizabeth Wellsandt: It can be a delicate balance just to try to work and figure out what each individual can tolerate. 

Jamie Nicole: Absolutely. 

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Jamie Nicole: You oftentimes hear the word flare. Can you delve a little bit more into what an osteoarthritis flare looks like? 

Dr. C. Benjamin Ma: It usually means a period of intense inflammation. And I tell people all the time that osteoarthritis is not a straight line. Some days are going to get better, some days are going to get worse. When it's actually a flare is when you have more symptoms. And it doesn't mean a flare lasts forever. Sometimes the flare will go away and feels better afterwards. What causes a flare is very variable. Could be trauma, could be activity, could be your health of the body, the stress you put on a joint. Sometimes it could be related to weather. 

Dr. Elizabeth Wellsandt: And it's important to learn how to respond to those flares, right? We don't want people to stop all their activity because they're having a flare. We want them to kind of work through how can they manage that. 

Jamie Nicole: How can having OA also impact your mental health? Because it is a lot, to be able to go from at one point in time being able to do whatever you want with your body, to your body basically telling you what you're going to do on any given day. 

Dr. Elizabeth Wellsandt: Yeah, undoubtedly. I mean, it's not only causing sometimes chronic pain but, as you mentioned, Jamie, also affecting the things that you love to do. Certainly there's an increased risk of people who have OA with things like depression and anxiety, sleep disturbances. It can be a little bit of a vicious cycle, right? Those mental impacts can influence some of the physical symptoms and how active we are. So, addressing mental health is very important. 

Jamie Nicole: Self-care also is obviously very important with any chronic condition. What are some other things that someone with osteoarthritis can do on their own to help manage their condition? 

Dr. C. Benjamin Ma: I think stay positive. Engage in other activities that could stimulate the brain or stimulate the rest of the body. Focus on the positive things that we could actually have an impact on. And some of the negative things, hopefully that will get better with the appropriate treatment. 

Dr. Elizabeth Wellsandt: And I would just add building a really strong support system around you, because you're going to have good days, you're going to have tougher days. And so having people that understand, at least to some degree, what you're experiencing and what you're going through can really be helpful when you're having one of those more challenging days or periods of time. 

Jamie Nicole: I know that this is a question that we get a lot, so I want to pose it to the both of you. What are the most effective treatments that you can do on your own at home? For example, hot and cold therapy, or taking supplements. What do you find is most helpful to your patients, managing the symptoms when they're at home? 

Dr. C. Benjamin Ma: I think simple treatment would be taking care of the joint itself when it's painful. People always ask about: Is ice better? Is heat better? You want to warm up a joint before you move it, and you want to cool it down after you actually finish exercising. So, before you exercise maybe at the start of the day, a warm shower, warm compress would get the joint moving a bit. When you finish exercising, ice the joint, cut down inflammation. That's usually a pretty good, reliable treatment. 

When the joint is flared up or inflamed, pain is very symptomatic. That's what actually limits people’s movement. A simple first line drug like Tylenol, it's really very effective for osteoarthritis. Same thing with the over-the-counter anti-inflammatory. There's some data on supplements. For example, chondroitin, sulfate and glucosamine. The data shows that there's some benefit, but the benefit's not very effective. If it helps you, great; if not, I won't pay too much attention to it. That's my thinking behind supplements. 

Dr. Elizabeth Wellsandt: One additional idea that I would add is: Sometimes if you're having a little flare or the pain is just increasing, sometimes using a cane or something to assist with how you're moving about can just help unload that joint a little bit and decrease some of the pain and allow you to be able to walk and move a little bit easier. 

Jamie Nicole: One of the things that bothers me the most, as it does with most people with osteoarthritis, is the morning time. For years, I've been having a heated mattress pad to warm me up in the morning. And then also at night, I can't stand cold sheets. Even if it's hot, I may have the fan on, but the sheets can't be cold. That has helped me a lot, when it's really bad in the morning, even though I'm going to the gym to work out and I don't necessarily always take a shower before I go to the gym. When I'm in a lot of pain, just getting in the shower, just to run the hot water over my back, over my body, helps a lot. 

You mentioned weather earlier as something that causes your symptoms to flare a little bit. Now I go to the barometric pressure app, in addition to the weather app, because it's about knowing what's going to happen, so I can manage other aspects of my life. If I know it's going to rain later on during the week, I can plan my activities, because I already know that I'm going to feel more pain than I normally would. I can adjust my schedule and manage my life better around both the weather and the barometric pressure. 

Dr. C. Benjamin Ma: Actually, a lot of patients share with us, too, is that you could be better than, more accurate than, a good weather person. Better than anybody. So, good job on that, yeah. 

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Jamie Nicole: Before each episode, we post a question on social media. For this episode, we asked: "What's one thing you really wish you knew about osteoarthritis when you were first diagnosed?" And so, we'd love to get your thoughts on a few of the responses. Shirley says she was diagnosed at 25 with osteoarthritis in her left knee. She had her first knee surgery at 28. “I wish I knew how to make other doctors believe what I told them. I always heard…” and I hear this one, too, “‘You are too young to have osteoarthritis,’ and they were wrong.” Not every doctor listens to you. They may dismiss you because of your age. What are some of your thoughts on what Shirley mentioned? 

Dr. C. Benjamin Ma: Osteoarthritis doesn't identify by age. We need to listen to our patients more and kind of make sure that we understand what they're going through. 

Jamie Nicole: Linda says to that question, "How to help slow down its progression with the right team of specialists to help me in the beginning." 

Dr. Elizabeth Wellsandt: Yeah, I think it's just so important that we make sure we equip people with the knowledge about what OA is and how we can manage it. And the sooner that we identify it, and then the sooner that patients are able to begin working with their team to manage it, the better off they're going to be in the long term. It's critical that we work with patients really early on, so that we can kind of manage symptoms and prolong the health of their joint. 

Dr. C. Benjamin Ma: And Jamie, one thing I want to add, too, is that, obviously, we don't want to have surgery unless we have to. But some of the joint replacements are some of the most successful operations we do. These are procedures that last 10 to 15 and even 20 years sometimes. It can make a profound impact on someone's mental health, activity level, how to perceive themselves also. 

Jamie Nicole: The last feedback that we have is from Kara and Henry. And Kara says she wished she knew that exercise and diet are vital. And in that same vein, Henry mentioned that to know that from the start: that you have to keep moving.  

Dr. Elizabeth Wellsandt: One of my colleagues that I have worked with in our physical therapy program, her slogan is “motion is lotion.” Our joints love to move. So, motion is lotion. And maybe that can stick with some people along the way. 

Jamie Nicole: I absolutely love that. At the end of every podcast, we like to ask for the top three takeaways. What are your top three takeaways, Dr. Ma, from this podcast? 

Dr. C. Benjamin Ma: We went through a lot. But I would say: Osteoarthritis is multifactorial, multiple courses; each course may have a different treatment. Staying active and using a joint is extremely important. There are great treatments for osteoarthritis, whether it's controlled pain, taking care of the arthritis with replacement… So, make sure you get the right medical care for you; and we can actually manage some of the symptoms with you together. 

Jamie Nicole: Dr. Wellsandt, what are your top three takeaways from this episode? 

Dr. Elizabeth Wellsandt: I'm just so appreciative for the opportunity to have this conversation and discussion with you all. We have great treatments, but we want to  continue to get better in what we're able to offer patients. We've talked a lot about the team approach, and the patient is really the center of that team. And so, you know, just how critical it is to listen to the patient and make sure that they're at the center of our decisions. But it really is this team approach: orthopedic surgeons, primary care physicians, physical therapists. We talk about dietitians, mental health specialists. It's just really the whole team is so critical. And then I think I'll just end with motion is lotion and leave it at that. (laughs) 

Jamie Nicole: I know firsthand how much movement has helped me. Motion is lotion, and movement is medicine. My top three takeaways, that's one of them: Movement is medicine. The other one is advocate for yourself. You all mentioned that this takes shape in different ways, and it's going to look different for everybody. So, if you feel that something is wrong, make sure that you're, number one, getting educated. And talking to your doctor and creating a team. Not just a medical team. That's the takeaway number two. But also a support group, because going through this journey isolated, it can be a heavy load to carry. But if you have some other people who also are going through the same thing ... to have someone to talk to who actually understands what you're going through… Make sure that you get connected to resources. Getting a diagnosis early is so important. Those are my takeaways for this episode. 

Dr. C. Benjamin Ma: There's so much we don't know. There's so much we could do better. That's why research is extremely important. Support the research we're doing in arthritis. 

Dr. Elizabeth Wellsandt: And I just want to say a thank you to the Arthritis Foundation for having platforms like this to discuss these topics such as OA and all the incredible resources that the Arthritis Foundation provides. Both to patients and also us as clinicians, just an incredible resource. 

Jamie Nicole: With that being said, for more arthritis resources, including information on osteoarthritis, please visit the Arthritis Foundation's website at arthritis.org. And if you have any suggestions about topics you'd like to see us cover or any ideas you want to share, please email us at [email protected]. Until next time, take care. 

PODCAST CLOSE: Thank you for listening to the Live Yes! With Arthritis podcast, produced as a public service by the Arthritis Foundation. Get show notes and other episode details at arthritis.org/podcast. Review, rate and recommend us wherever you get your podcasts, on Apple, Spotify and other platforms. This podcast and other life-changing Arthritis Foundation programs, resources and services are made possible in part by generous donors like you. Consider making a gift to support our work at arthritis.org/donate. We appreciate you listening. And please join us again!